ee eee A By i 8 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION . < ANH aoa rd nt 09 AGENCY FOR HEALTH CARE ' ADMINISTRATION, ; a Petitioner, AHCA No.: 2002011471 vs. AHCA No.: 2002008974 DOAH No.: 02-1277 FIP MERIDIAN PARK VILLAGE LIMITED ? a PARTNERSHIP d/b/a DONNELLY PLACE Chine Respondent. —_ es FINAL ORDER THEREFORE, it is ORDERED and ADJUDGED that the Parties hereto are directed to comply with terms of the Joint Stipulation and Settlement Agreement. DONE and ORDERED this wad. day of Kes peed! , 2002, in Tallahassee, Leon County, Florida. ee 2? Chelle: oe Rhonda M. Medo Ss, , Secretary Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE Copy OF A NOTICE OF APPEAL WITH AGENCY CLERK AND A SECOND COPY, ALONG WITH FILING FEE as PRESCRIBED BY LAW, IN THE DISTRICT COURT OF APPEAL WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES, THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Alba M, Rodriguez Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Fl 33166 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice- Mail) Wendy Adams Office of the General Counsel Agency for Health Care Adminictratinn 2727 Maha- Talariassec, Mund gesuu (Interoffice Mail) Loren E, Braner, Jr. Administrator Donnelly Place 2792 Donnelly Drive Lantana, Florida 33462 (U.S. Certified Mail) Jonathan S, Grout, Esq. Law Office of Goldsmith, Grout & Lewis, P.A. 2180 North Park Avenue Suite 100 Winter Park, Florida 32790 (U.S. Mail) J.D. Parrish Administrative Law Judge Division of Administrative Hearing 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. Mail) ERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the above-named addressees on this day of TT , 2002. C 1, A. Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 - Tallahassee, Florida 32303 STATE OF FLORIDA Cb LO ey DIVISION OF ADMINISTRATIVE HEARINGS Con AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 02-1277 AHCA No.: 2002011471 v. AHCA No.: 2002008971 Meridian Park Village Limited Partnership, d/b/a Donnelly Place, Respondent. STIPULATION AND SETTLEMENT AGREEMENT —eM_ NT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (“Agency”) through their undersigned representatives, and Meridian Park Village Limited Partnership, d/b/a Donnelly Place (“Donnelly Place”) pursuant to Sec. 120.57(4), Florida Statutes (2000) each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: = WHEREAS, Donnelly Place is a skilled nursing facility licensed pursuant to Chapter 400, Part II, Florida Statutes (2001) and Chapter 59 A-4, Florida Administrative Code (2001); and WHEPEAS, the Agency has turisdictior by virtue of being the regulatory and licensing authority over nursing homes pursuant to Chapter 400, Part II, Florida Statutes; and WHEREAS, the Agency served Donnelly Place with a notice of intent to impose a conditional rating on its license and with an Administrative Complaint notifying of its intent to impose an administrative fine of $7,500.00 for three Class II deficiencies cited by the Agency on a Survey conducted January 10, 2002 for (1) failure to give a resident an opportunity to refuse a transfer to another room within the facility; (2) failure to and (3)failure to ensure that a resident who entered the facility without pressure sores did not develop a pressure sore. WHEREAS, Donnelly Place filed petitions as to the conditional rating and administrative fine; and WHEREAS, the Parties have negotiated and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All recitals are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the Parties, 3. Upon full execution of this Agreement, Donnelly Place agrees to a withdrawal of its Petitions for Formal Administrative 2 Proceedings; agrees to waive any and all appeals and Proceedings; agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), a formal Proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida Statutes; and 4. Upon full execution of this Agreement, Donnelly Place agrees to pay Three Thousand Seven Hundred Fifty dollars ($3,750.00) to the Agency within 30 days of the entry of the Final order. The Agency will withdraw Count I of the Administrative Complaint. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in the Circuit Court in Leon County, Florida. S. Donnelly Place agrees to accept the conditional rating effective January 10, 2002. 6. Donnelly Place neither admits nor denies the allegatians given rise to the imposition of a conditional rating and Administrative Complaint. The Agency agrees that it will not TR de a “enalty against Donnelly Place as a@ result of the January 10, 2002 survey, however, no agreement made herein shall preclude the agency from imposing a Penalty against nee Donnelly Place for any deficiency identified in a future survey of Donnelly Place which constitutes a4 “repeat” deficiency from the January 10, 2002 survey. 9, This Agreement Shall become effective on the date upon 10. Donnelly Place, for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health “Care Administration, and its agents, representatives, and attorneys of and from all Claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, including, but not limited to, any Claims that were or may be asserted in any federal or state court or. administrative forum, including any claims arising out of this agreement, by or on behalf of Donnelly Place or related ll. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph ten (10) of this Agreement. 12. The undersigned have read and understand this 13. This Agreement contains the entire understandings and agreements of the Parties. 14. This Agreement supercedes any prior oral or written agreements between the parties, 15. This Agreement May not be amended except in writing. Any attempted assignment of this Agreement shall be void. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. ne haste Shige!) Ch LSBA/ Jonathan gs, Grout, Esquire Deputy Secretary Goldsmith, Grout ¢ Lewis, P.a, Agency for Health Care 2180 Park Avenue North, #100 Administration Post Office Box 2011 2727 Mahan Drive Winter Park, Florida 32790-2011 Tallahassee, Florida 32308 407/740-0144 Attorneys for Respondent Dated: Ef 2fb) Florida Bar No. 296066 Dated: P-/O - O2— EL UL ot William H. Roberts Acting General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Dated: Fl sf ga

Docket for Case No: 02-001277